Provider Demographics
NPI:1114483369
Name:ASSURANCE COMFORT LIVING HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:ASSURANCE COMFORT LIVING HOME HEALTH AGENCY
Other - Org Name:ASSURANCE COMFORT LIVING HOME HEALTH AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-416-4685
Mailing Address - Street 1:11052 CAPTAIN DR FL 34608
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-5008
Mailing Address - Country:US
Mailing Address - Phone:813-416-4685
Mailing Address - Fax:
Practice Address - Street 1:10394 AKRON ST FL 34608
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-5001
Practice Address - Country:US
Practice Address - Phone:813-416-4685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253J00000XAgenciesFoster Care Agency
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021961100Medicaid